Homophobia and the HIV/AIDS Epidemic: Towards a New Understanding

Gay and bisexual men of all races continue to be the most heavily impacted population by the HIV and AIDS epidemic. In many jurisdictions across the country, the HIV infection rates for young gay and bisexual men of color are going up.

Fortunately, many national LGBT organizations, like the Human Rights Campaign, are renewing their efforts to address the HIV and AIDS epidemic. On the 6th National Gay Men’s HIV/AIDS Awareness Day, September 27, we must take this opportunity to reflect on the relationship between homophobia and the HIV and AIDS epidemic. How can we think of the significance of this relationship and how it impacts our work to challenge homophobia and reach an AIDS-free generation?

The relationship between HIV and gay and bisexual men has existed since the beginning of the epidemic, which is most clearly demonstrated by HIV’s former name, Gay-Related Immune Deficiency, or GRID. More than 30 years later, while the National HIV/AIDS Strategy acknowledges HIV does not discriminate, the epidemic is concentrated in both particular geographies and populations, specifically gay and bisexual men of all races.

The Strategy goes as far to argue that “the United States cannot reduce the number of HIV infections nationally without better addressing HIV among gay and bisexual men.” This has motivated community based organizations and health departments across the country to refocus their efforts towards gay and bisexual men.

Homophobia is often noted as one of the drivers of the epidemic for gay and bisexual men, but I want to challenge us to think about homophobia’s relationship to both HIV/AIDS and to LGBT politics in a more holistic way. I think there are (at least) two different ways to understand the concept of homophobia.

Homophobia is most commonly associated with attitudes, beliefs, or actions which express hatred, fear, or disdain of actual or perceived homosexuality. This understanding of homophobia at an interpersonal level has led to many important conversations, such as the impact of stigmatization. Many social marketing campaigns feature HIV-positive gay men and include their motivations and systems of support to stay in HIV medical care.

Another way to understand homophobia that, I think, is more challenging is to look at it as a force that informs how gay men organize their lives. For this, I am borrowing from French philosopher Michel Foucault. In an interview titled “Friendship as a Way of Life,” he says, “I think that’s what makes homosexuality 'disturbing': the homosexual mode of life, much more than the sexual act itself. To imagine a sexual act that doesn't conform to law or nature is not what disturbs people. But that individuals are beginning to love one another - there’s the problem.”

Foucault goes on to argue that part of what is so appealing about “being gay” is the opportunity “to try to define and develop a way of life.” The focus here is not on how someone identifies, but to understand how they are organizing their life in relation to their environment. The development of gay communities in urban areas like New York City and San Francisco, for example, is the result of gay people creating institutions like bars, shops, residences, etc. to provide physical space for other gay people to organize their lives.

So how can understanding homophobia in relation to how gay men organize their lives help us understand the HIV/AIDS epidemic for gay and bisexual men? After 30 years of this epidemic, it is unsettling to think that we have a wealth of knowledge about how HIV works, how to prevent it, and how to treat it effectively and safely, yet gay and bisexual men continue to be disproportionately impacted.

If we look at the lives of HIV-positive gay and bisexual men through this lens, it forces us to take a more holistic approach to understanding how this epidemic affects different communities of gay and bisexual men. An HIV-positive Black gay man in Chicago may organize his life differently than an HIV-positive gay Latino in the Bronx. Issues like poverty, citizenship status, violence, and homelessness become central to the problem because they directly impact how gay men organize their lives.

Too often, these issues that are central to the lived experiences of HIV-positive gay men are pushed to the side, or they are minimally recognized as “social determinants.” If we center these issues as essential to combating the HIV/AIDS epidemic for gay and bisexual men, we will be able to develop more creative strategies that respond directly to this epidemic.